Ultrasound: Life-saving story challenge

I have got a special post for you today. I have just spent a week doing some tertiary Obstetric Anaesthesia – and man, it can be tough, some really scary scenarios. At one point we had 30 health professionals in an operating theatre to look after one lady and a baby! For me this was a real eye-opener. Seeing the good, the bad and the sometimes absurd side of super-specialist care. After all that stress I think I need a good rest…. so…

I am having a holiday this week – however I don’t want to leave you without a dose of Broome docs for the week. So I am going to open a competition. Not a clinical quiz this time. This time I am after a bit of writing from you – the readers.

As you must be aware – I am an ultrasound tragic. I have been missing my probes this week and need an infusion of gel-mediated goodness…

So I am offering a free copy of the Inkling version of “Introduction to Bedside Ultrasound – vol 1“. Matt and Mike form the ultrasoundpodcast.com have transferred their first volume of this ground-breaking textbook over onto a html platform – which basically means you can read the interactive / video text on any computer – no iPad required. This is making the learning more universal for all. It is priced at $30 – but worth a whole lot more.

So how do you win this free online text – and become an US superstar?

Tell me your best ultrasound story. I want a brief story – one where you used your bedside US skills to change to outcome for your patient – maybe you clinched a great diagnosis, averted an error or just saved the day with your “Xray vision”.

Here are the rules –

Tell the story in a few hundred words

No identifiers – no names, dates or geographic locations

Reply into the comments box below

Entries close on 8th July 2013

Judgement is by me and a small committee of mates

If you win I will send you a free copy of the text and am offer to record your story on the Broome Docs podcast.

So don’t be shy get writing. Tell us your moment of US glory and follow the entries – we love a good yarn here at the blog.

Comments

I have a case where ultrasound may well have saved a patients life. Sadly, it wasn’t by me – my ultrasound “skills” nearly killed her.

I was working a Sunday evening shift in “fast-track” and I went to see a developmentally-delayed middle aged woman with her carer. She had presented the evening before complaining of a swollen leg. We don’t have formal ultrasound on a Saturday evening so she was given a shot of clexane and asked to return during the day on Sunday. After examining her, I thought both legs were swollen (no sign of heart failure) and that a DVT was clinically unlikely. It was going to be at least a 4 hour wait for the formal ultrasound so I told the patient and carer that I would do a scan and maybe we could spare her the wait.

I got great view in both legs including calf veins which I often struggle with. I was convinced that there was no DVT in either leg – never seen such big, juicy veins. The only thing that was unusual was that I had to push harder than usual to compress the veins. I had a chat to the carer and in the end we decided to wait and get a formal scan.

The ultrasonagrapher rang me with the results. “You’re lucky I’m on. I always scan above the inguinal ligament. She’s got clot in both inguinal veins and the IVC all the way to the diaphragm.”

“But no DVT in the leg, right?” I asked.

She hung up on me.

The patient was admitted under haematology.

Having to push hard to compress the veins should have set off alarm bells in my head, particularly when combined with bilateral leg swelling. It didn’t but I will claim that I had a vague sense of “something is not right here” and hence I kept her for the formal scan.

If there is a take home message, I think it is that you always need to ask can I trust my scan or do I need to confirm it with a formal ultrasound? I’ve missed a non-occlusive DVT in the past so I’m a bit nervous about ruling out a DVT -- which, in this case, is just as well.

I am declaring you the winner of the US Book. Nice case and great honest insight into the potential pitfalls of bedside US.
Get onto my email and let me know your address and I wll send you the code and links

I was a first year emergency medicine resident with a whole of a month or two working at the ED when my “US-life saving story” happened. Thankfully, my boss was a great promoter of ultrasound use so I was very inclined to use the US at all times. And, truthfully, that early in my career, the aorta was basically the only thing I kind of knew how to look at.
So, one fine morning, the paramedics brought in a 50+ yo male with severe dull pain in his abdomen or back, or both – he couldn’t really tell. He was hemodynamically stable but very restless and in a lot of pain. The thing that struck me was that he was actually a physician, a general practitioner, and he was in so much distress that he couldn’t differentiate the pain at all. While the iv line was being placed and analgesia prepared and infused I grabed the US probe and placed it on the abdominal midline and a huge round pulsating hypoechogenic mass was staring back at me from the screen. I’m pretty sure my heart rate went up slightly as I looked around the room, searching for anybody that’s seeing the same thing I’m seeing. I caught a confirmative (and worried) nod from a senior doctor, picked up the phone and called a surgeon about the ruptured AAA.
This story had a happy ending. Surgery was performed in time, with excellent outcome; the patient was back at work in a couple of months;
I believe that in a given clinical scenario anybody with at least some basic US knowledge would recognize a ruptured AAA – because the ultrasound is cool like that ☺.

hello, i work in a 8-bed medical icu. we routinely do echo, but we are just starting with lung us. recently we had a 55-yo diabetic, CAD, obese man, whom we had succesfully treated for sepsis with AKI and delirium. he recovered and was sent to the ward. about 10 days later or so, he was referred back to our icu for deterioration in consciousness. he was admitted on sunday evening, when he was found to be somnolent, confused, but maintainign his airway and sated in upper 90s on a face mask. when i reviewed him the next morning he was soporous, agitated on awakening, hypoventilating. breath sounds were nearly absent on the left and he was hemodynamically stable, with good diuresis, afebrile. the blood gas showed a marked hepercapnia, mild acidosis, normal lactate. we put a NIV mask on. i reviewed hs medical chart for sedatives but there were none. we checked the blood gas in about an hour later but hypercapnia didnt improve at all…
then we dragged the us to the bedside, we did echo which was unremarkable. we then examined the chest, and i suspected fluid in the left chest, but there was none. instead, there was heart literaly everywhere, no lung sliding, and a “parenchymatous” organ in the chest, which of course was his consolidated left lung. we planned urgent bronchoscopy, but we decided to intubate the patient, since the LOC didnt improve at all with the NIV. it was uneventful, and the bronch showed plugged left main with mucus, which was then cultivated and contained no bacteria but Candida. he was treated with fluconazol and made a slow recovery, he needed a tracheostomy to wean from the vent, but he was decanulated eventually and discharged home.
i had done a few chest us before this, especialy for effusions, but this was something new. it definitely saved the day and i added yet another us skill to my armamentarium. sometimes i wonder, how i could have been doing things without ultrasound before. ..
michal
PS. well done on the blog!!!